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NPI Code Detail

MEDICARE: KIMBERLY SUE HASKELL LLPC

MEDICARE: KIMBERLY SUE HASKELL LLPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor6401010439MI

General Provider Information

NPI Number : 1467651141
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY SUE HASKELL LLPC
Provider Business Mailing Address
First Line : 2532 N DETTMAN RD
Second Line :
City : JACKSON
State : MI
Zip : 49201-8837
Country : US
Telephone Number : 517-787-7920
Fax Number : 517-787-2440
Provider Business Practice Location Address
First Line : 330 W MICHIGAN AVE
Second Line :
City : JACKSON
State : MI
Zip : 49201-2121
Country : US
Telephone Number : 517-787-7920
Fax Number : 517-787-2440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2007
Last Update Date : 07/13/2007

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Directions to “ KIMBERLY SUE HASKELL LLPC” Practice Location

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